The Role of Use Scenarios in Developing a Community Health Information System

by Bharat Mehra, Ann Peterson Bishop and Imani Bazzell

This paper discusses use scenarios as a means of representing social context, values and practices in
information system design. Currently the three authors of this paper are working on a community-based action research project devoted to the development of Web-based health information resources for African American women. The
original proposal for this project, which is funded by the Institute of Museum and Library Services, outlined a plan for applying use scenarios to ground our system development more firmly in the social context of intended users.

The current project extends Bharat Mehra's earlier cross-disciplinary research in community development and information exchange. His work on the East St. Louis Action Research Project (ESLARP) involved working closely
with the community, analyzing their needs and making recommendations for re-building the physical and cultural landscape based on positive community participation in the design process. As part of the ESLARP project, he studied the
religious life of an African American community (see the ESLARP Website at www.imlab.uiuc.edu/eslarp/la/ LA437-F95/main.html) as well as the concerns of local business owners about the process of historic preservation in downtown
Champaign, Illinois. The current project extends Ann Bishop's Community Networking Initiative research (supported by the Telecommunications and Information Infrastructure Assistance Program and the Kellogg Foundation) and Imani
Bazzell's community action work through SisterNet (supported by the Ms. Foundation for Women and the Black United Fund).

The creation of online community information systems demands an assessment of the information
needs, situational attributes and sociocultural contexts of the people who live in the local area served. This is all the more essential in the context of user groups from the traditionally underserved segments of society in order
to bridge the "digital divide" that exists between the information haves and have-nots.

Developing Use Scenarios for Online Community Health Information

Use scenarios are defined by John M. Carroll in the introduction to the book Scenario-Based Design: Envisioning Work and Technology in System Development
(1995) as "use-oriented design representations" that seek to establish a concrete model of users' tasks to guide system development and evaluation. Use scenarios predict and record representative and consequential user goals and activities early and continuously in the system lifecycle. They promote user participation such that the users become empowered as initiators in the analysis of information about their expectations and requirements and are not treated as mere informants in the design process. This is especially important to develop a more complete picture of the context of information-seeking and technology use for marginalized groups who are often on the fringes of system design and evaluation, such as the African American women in the community with which we are currently collaborating.

Our development of use scenarios also derives from Brenda Dervin's sense-making research. In this research people describe a) specific situations that caused them to reach out for information, b) steps they took to
bridge gaps that impeded their ability to get needed information and c) how needed information would be used or help. Dervin's triangulated "situation/gap/use" framework produces a kind of scenario for understanding behavior
surrounding a central focused activity, such as, in the case of our study, resolving health concerns. Generating such descriptions of individual occasions of use ignores any static user demographic or occupational characteristics
that do not express the reality and nuances of a particular lived situation.

The Alexandria Digital Library (ADL) is one project where an understanding of "user scenarios" helped in establishing system requirements.
In order to assess the needs of target user groups, depictions of specific information searching and use situations were elicited. In addition, broader descriptions of the goals, activities and constraints that typify each intended
user group were formulated (see Hill et al., in press; and the Alexandria Web Team's collection of use scenarios at www.alexandria.ucsb.edu/~hill/scenarios.html). For example, earth scientists typically seek large datasets, work in
a high-tech environment, have extremely particular search criteria and require that ADL be closely "plugged-in" to the working environment in which they manipulate data.

We are in the early stages of developing a set
of use scenarios for local African American women in the health information domain. Our first step was to review interview and discussion group data related to African American women's health concerns, which derives from earlier
Sisternet and Prairienet/CNI projects. Currently, we are eliciting narratives that depict typical problematic health situations and elaborating them in terms of community health information needs, practices, gaps and uses. We are
beginning with focus groups in which women discuss

§

their visions of healthy Black women;

§
important health concerns or situations they recently experienced;

§ where and how they typically get and use health information;

§ barriers they experience and what works well in using health resources;

§ their use of computers; and

§ actions that they or
other project participants can take to improve health information resources and services.

These components are integral to developing use scenarios for a Web-based community health information service for African American women, since they holistically bring together essential needs, concerns, perceptions,
expectations and individual as well as community behavior related to the use of health services, information and technology. An important next step will be to articulate the format of the use scenarios we collect for informing the
design and evaluation of Web-based information resources.

Basic sociocultural and environmental factors influence women's understanding, beliefs, needs and practices related to the use of local health services. Black
women often live and work in higher risk areas and suffer exposure to greater levels of pollution, pesticides, chemicals and other toxins, congestion, violence, noise and stress. . . a prescription for disease. Economic survival
and constraints, safety, overall quality of life, life burden, functional and social support and experiences with racial stereotypes and prejudice are influential in shaping health practices.

African American women in
our community conceptualize their physical, emotional, spiritual and intellectual health not in isolation, but in terms of their relationships and interactions within the "whole person" that encompasses family relationships and the
broader lifeworld. They often function as the primary or sole caregiver in their immediate (and sometimes extended) families, which means that their health needs usually come last. The role of religion/spirituality in shaping
beliefs, attitudes and actual experience reflecting personal control over one's health is potent. Access to comprehensive and high quality health care and the nature of the relationship between provider and patient are other
important issues.

African American women have a common vision of becoming self-respectful and self-reliant, honest, confident and assertive, as well as healthy at all levels, as individuals and social units, who
would be able to identify their own health-related needs and seek the appropriate resources to fulfill those needs. Physical health concerns encompass reproductive/sexual health, nutrition, disease awareness and prevention, fitness
and safety. Some commonly identified diseases are breast cancer, diabetes, high blood pressure, kidney disease, HIV/AIDS and lupus. Television, friends, family and the Web were identified as primary resources and tools that could
assist women in becoming healthier in the specific domains.

A major perceived barrier in achieving good physical health is the lack of consistent role models and culturally sensitive health professionals in local and
national Black communities for disease awareness and prevention. Also frequently noted in our focus groups was the perception that women need more confidence and self-esteem in demanding good service from health providers. A major
perceived barrier is the lack of accessible information, in other words, information that is convenient, jargon-free, relevant and culturally appropriate. Additionally, several African American women believe the history of chronic
illness in the Black community leads to a high level of tolerance/acceptance of disease as a part of life.

Implications for Information Service Design and Delivery

By taking a social informatics
approach to information system needs assessment and design, we hope to develop a Web-based health information service that African American women in our community will find usable, useful and congenial. The women from whom use
scenarios were elicited and who will use them to evaluate existing Web resources will refine the preliminary set of use scenarios developed from this project. The final stage of our current project will involve the design of a new
set of networked information resources, access policies and implementation practices in order to enhance participation and build collaboration between community members from traditionally underserved social segments and those who
provide health information services.

Our initial development of use scenarios is helping us define the content and functionality that should be provided in the Website we plan to create. For example, the relevance of
home remedies for fulfilling health information needs - often ignored and considered inappropriate by professional health providers - was noted in several focus groups. Additionally, the development of convenient and appropriate
interactive systems (like bulletin boards where role models/mentors/health providers from the local Black community would supply support and advice) was discussed.

For Further Reading

Carroll, John M. (Ed.). (1995). Scenario-based design: Envisioning work and technology in system development. New York: Wiley.

Imani Bazzell is the founder and director of SisterNet, a local network of African American
women committed to the physical, emotional, intellectual and spiritual health of Black women. Professionally, she splits her time between SisterNet, the Center for Multicultural
Education at Parkland College and independent consultation with public schools, colleges and universities, unions, not-for-profit and state agencies and community groups on racial
justice, gender justice, healthcare access and leadership development. She can be reached by e-mail at IBazzell@parkland.cc.il.us

Bharat Mehra is a research assistant for the IMLS project. He is currently a doctoral student in the University of Illinois Graduate School of Library and Information Science.
Mehra previously worked on the East St. Louis Action Research Project (ESLARP). Mehra has master's degrees in landscape architecture and in South and West Asian Studies. He can be reached by e-mail at b-mehra1@uiuc.edu

Ann Peterson Bishop is assistant professor in the Graduate School of Library and
Information Science at the University of Illinois, Urbana-Champaign. She can be reached by e-mail at abishop@uiuc.edu.